Influence of changes in the intestinal microbiome on the course and progression of metabolically associated fatty liver disease

Abstract

Introduction: The frequency of detection of metabolically associated fatty liver disease in the population of developed countries is becoming a non-infectious pandemic, the growth drivers of which are obesity and diabetes mellitus. Currently, metabolically associated fatty liver disease occupies a firm position in the list of the most common liver diseases all over the world. Chronic liver diseases are accompanied by pronounced pathological changes in the composition of the human microflora, manifested by a deficiency of obligate microorganisms and microbial contamination of the small intestine, which requires a long-term therapeutic correction aimed at normalizing the gut microflora. Objective: to study the impact of the intestinal microbiome disorders on the course and progression of metabolically associated fatty liver disease. Materials and methods. The study included 105 patients with metabolically associated fatty liver disease. The diagnosis of metabolically associated fatty liver disease was exhibited on the basis of proven liver steatosis in combination with one of the following criteria: overweight/obesity, type 2 diabetes/insulin resistance syndrome, signs of metabolic dysregulation. Patients underwent a comprehensive clinical and laboratory study. The stage of liver fibrosis was determined using ultrasound elastography (Fibroscan). The study of the intestinal microbiome was carried out using the method of gas chromatography-mass spectrometry. Results and its discussion. It was found that 68.6% of the cases of metabolically associated fatty liver disease were associated with obesity, 27.6% - with overweight body mass. It was revealed that in most patients there was an increase in ALT level, a violation of lipid metabolism (increased levels of total cholesterol, LDL and triglycerides, as well as a decrease in HDL levels), the development of insulin resistance syndrome. Violation of the of the intestinal microflora was revealed in 71.4% of patients. Patients with impaired intestinal microflora have higher levels of ALT, cholesterol, LDL, triglycerides, HOMA-index and lower levels of HDL, higher stage of fibrosis compared to the group without impaired intestinal microflora. Conclusion. Disruption of the intestinal microflora occurs in the majority of patients with metabolically associated fatty liver disease and has a negative impact on the course (leading to more pronounced lipid metabolism disorders, higher ALT and HOMA index levels), as well as the progression of metabolically associated fatty liver disease (leading to a higher stage of fibrosis).